Author: Roxanne Nelson
Acupuncture can improve subjective symptoms of dry mouth in patients with radiation-induced xerostomia, according to the results of a pilot trial. When treated twice a week for 4 weeks with acupuncture, oncology patients who received radiation treatments to the head and neck area reported significant improvements in physical well being and quality of life.
The results of the trial, published online April 17 in Head & Neck, showed that acupuncture relieved symptoms as early as 2 weeks after starting therapy, with the benefits lasting for at least 1 month after treatment ended.
Although this was a pilot study, the results appear quite encouraging; little or no recovery is generally seen in these patients after they reach the damaging threshold of radiation. But all patients in this study had reached the damaging threshold, explained senior author William Chambers, DMD, MS, chief of the Section of Oncologic Dentistry and Prosthodontics at the University of Texas MD Anderson Cancer Center in Houston. “They all received over 50 Gy of definitive external-beam radiation therapy,” he said.
However, the data did not find a change in measured stimulated or unstimulated salivary flow, even though the patients reported symptom relief. “There was no statistically significant increase in saliva flow from baseline, but there was a positive trend, with a spike for unstimulated saliva [P = .08],” Dr. Chambers told Medscape Oncology.
The researchers also note that basal and salivary flow rates vary significantly among individuals, and therefore, subjective perceptions and objective measurements do not always correlate. A definitive threshold of increased saliva output that results in a clear clinical benefit has not been established, so even a small increase can provide relief to the patient.
Improvements Seen in Subjective Symptoms, Not Objective Differences
In this study, Dr. Chambers and colleagues evaluated the efficacy of acupuncture in alleviating xerostomia in 19 patients with head and neck cancer who had undergone radiation treatment.
All study participants completed the Xerostomia Inventory and the Patient Benefit Questionnaire at baseline and then throughout the study period. Objective measurements of salivary flow were collected with the subjective data, and unstimulated whole salivary flow rate and stimulated salivary flow rate were assessed.
At weeks 4 and 8, patients reported symptom improvement, reflected in both the Xerostomia Inventory and the Patient Benefit Questionnaire scores. The mean response rate, measured by the Xerostomia Inventory, was 40%, and at the end of the fourth week of treatment, 44.4% had achieved a partial response. This percentage rose to 55.6% by week 8.
Unlike subjective measures, there were no differences in the unstimulated whole salivary flow rate or the stimulated salivary flow rate between baseline and the end of the follow-up period (week 8). A small elevation in both the unstimulated whole salivary flow rate and the stimulated salivary flow rate was seen 1 week after acupuncture treatment.
Patient Benefit Seen, Larger Trials Needed
It appears that there was a clear clinical benefit to patients, even if it could not be quantified using current measuring tools, explained Dr. Chambers, and even small changes in salivary flow can result in increased oral comfort.
It is also possible that the results could be attributed to a placebo effect, at least in some patients. However, the researchers do note that patients who have had major salivary glands irradiated do not spontaneously improve after 4 months, so the improvements in this trial “were most likely attributable to the acupuncture treatment rather than spontaneous recovery.”
None of the patients in the study experienced adverse events related to their treatment, and complications resulting from acupuncture are rare. Based on the relative safety of the procedure and the fact that patients experienced relief, Dr. Chambers feels that acupuncture is an intervention that can be considered for this population. “As long as patients are interested and understand these results are preliminary,” he said.
Larger placebo-controlled trials are needed for more definitive results, and the researchers write that they plan on conducting these trials in the future, but this project is a “first step in verifying promising reports from previous research.”
Head Neck. published online before print April 17, 2009. Abstract